As far as the World Health Organization (WHO) is concerned, there’s a looming threat of an as-yet-unknown international epidemic — one that could potentially be deadly. In the WHO’s latest R&D Blueprint of priority diseases, the yet-to-be-identified culprit behind the next global pandemic is called simply “Disease X.” It might seem like little more than an empty guess, but Disease X represents much more than that.
At first, including an unidentified disease with the potential to wreak havoc on humanity feels kind of alarmist — but it isn’t meant to create panic. According to a statement explaining the R&D Blueprint, “Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.”
The list also includes several known diseases that have already reached epidemic levels in parts of the world; among them Crimean-Congo hemorrhagic fever (CCHF), Ebola, Marburg, and Zika viruses.
Preparedness is Key
To be clear, we don’t yet know what Disease X is. It might not even exist yet. But the possibility of a life-threatening, global epidemic is not science fiction, and that’s why it’s important to be prepared.
The inclusion of Disease X in the agency’s R&D Blueprint marks the first time the WHO has included an unknown pathogen. The decision is rooted in the belief that humanity has learned a thing or two from its past experiences with global pandemics, and that it’s crucial to anticipate what could be and prepare accordingly.
“History tells us that it is likely the next big outbreak will be something we have not seen before,” John-Arne Rottingen, Research Council of Norway CEO and WHO committee scientific adviser, told The Telegraph. Of course, that doesn’t mean there’s less work to be done to combat existing diseases. If anything, the efforts go hand in hand.
“It may seem strange to be adding an ‘X’ but the point is to make sure we prepare and plan flexibly in terms of vaccines and diagnostic tests,” Rottingen explains. “We want to see ‘plug and play’ platforms developed which will work for any, or a wide number of diseases; systems that will allow us to create countermeasures at speed.”
So, how do we prepare for Disease X? To start, we’ll need research — and lots of it. Perhaps equally important will be addressing an issue that ails much of the world today: a lack of adequate health coverage. As he stood before audiences in Dubai earlier this year, WHO chief Tedros said that “Universal health coverage is the greatest threat to global health.”
Indeed, the lack of access to even the most basic health coverage is among the factors that could allow Disease X to morph from a mysterious possibility into a dreadful — and deadly — reality. Coupled with the habits of a globalized world, lack of healthcare would also make it easier for diseases to spread.
In adding Disease X to its list, this is perhaps the most important point the WHO wants to highlight. The agency also aims to raise awareness about how humanity’s choices can potentially pose a great threat to our species.
Marion Koopmans, another WHO adviser, told The Telegraph that as the world develops, the intensity of human and animal contact is increasing, which “makes it more likely new diseases will emerge, but also modern travel and trade make it much more likely they will spread.”
To that point, Rottingen pointed out in Dubai last month that as the world’s ecosystems change and our habitats evolve, diseases in animals making the leap to humans is “probably the greatest risk.” In fact, as far as viruses are concerned, that evolution is very much a natural process — one that we need to be aware of and prepare for.
Scientists believe there are more than 1.6 million viruses in birds and mammals that we haven’t discovered yet. Approximately half of those viruses could potentially infect and cause illnesses in humans.
All it would take is one to unleash the next global pandemic.
That’s why a global cooperative, led by researchers at the University of California, Davis, has set out to identify them. In a paper published on Friday, the researchers established their goals for the Global Virome Project, an initiative to identify the unknown viruses lurking on Earth.
Beyond finding these elusive zoonotic threats — meaning the viruses are found in animals but could potentially make the leap to humans — the cooperative also envisions putting a stop to them. By knowing what we’re up against, humanity could be far better prepared to handle deadly viruses outbreaks across large areas; this project might be the key to preventing the next pandemic.
“It is time to move from reactionary mode, chasing the last horrible virus, to a proactive one,” said Jonna Mazet, Executive Director of the One Health Institute at the University of California, Davis, School of Veterinary Medicine and the paper’s lead author in a press release. “We can and will finally be able to identify future threats and take the steps necessary to prevent the next pandemic.”
A Pound of Cure
Over the next decade, the $ 1.2 billion Global Virome Project will work to identify about 70 percent of those potential threats. The cooperative plans to build on previous work done by the United States Agency for International Development’s PREDICT program, once of the agency’s four Emerging Pandemic Threats projects. PREDICT has identified more than 1,000 previously unknown viruses… but that accomplishment falls far short of the Global Virome Project’s ambitious goal.
The are several key pieces of information researchers need to know about a virus in order to establish its “ecological profile”: where it originates, where it thrives, what — or who — it infects, and how it’s transmitted, to name a few.
The sooner the team establish these characteristics, the sooner medical professionals can target people who are at the highest risk of emerging diseases that we don’t even know exist yet.
We have a problem. A serious one. At any moment, a life-threatening global pandemic could spring up and wipe out a significant amount of human life on this planet. The death toll would be catastrophic. One disease could see as many as 100 million dead.
“This is not some future nightmare scenario,” said Tedros (as he prefers to be called by Ethiopian tradition). “This is what happened exactly 100 years ago during the Spanish flu epidemic.” A hush fell across the audience as he noted that we could see such devastation again, perhaps as soon as today. Tedros was equal parts emphatic and grave as he spoke: “A devastating epidemic could start in any country at any time and kill millions of people because we are still not prepared. The world remains vulnerable.”
What is the cause of this great vulnerability? Is it our inability to stave off Ebola? Rising incidents of rabies in animal populations? An increased number of HIV and AIDS cases?
No. The threat of a global pandemic comes from our apathy, from our staunch refusal to act to save ourselves — a refusal that finds its heart in our indifference and our greed.
“Universal health coverage is the greatest threat to global health,” Tedros proclaimed. As the audience shifted in their seats uncomfortably, he noted that, despite the fact that universal health coverage is “within reach” for almost every nation in the world, 3.5 billion people still lack access to essential health services. Almost 100 million are pushed into extreme poverty because of the cost of paying for care out of their own pockets.
The result? People don’t go to the doctor. They don’t seek treatment. They get sicker. They die. And thus, as Tedros explained, “the earliest signals of an outbreak are missed.”
Surveillance is one of the most vital forms of protection the world’s public health agencies can offer, but these agencies rely on the money of the governments they serve. And in the United States, which is presently enduring a flu season of record-breaking severity, the Centers for Disease Control and Prevention (CDC) recently announced they would be cutting their epidemic prevention programs back by 80 percent. Programs for preventing infectious diseases, such as Ebola, are being scaled back in 39 of the 49 countries they’ve been employed in, according to The Washington Post.
The reason? Quite simply, governments are pulling money from these programs, and it’s not clear whether any more will ever be allocated — at least, not in the U.S. during the current administration.
It might seem a bit obtuse. But, as Tedros pointed out, too often we “see health as a cost to be contained and not an investment to be nurtured.”
Aside from the obvious — avoiding a global pandemic that ravages humanity — healthy societies are advantageous for reasons that are more economic than epidemiological. “The benefits of universal health coverage go far beyond health,” Tedros said. “Strong health systems are essential to strong economies.”
We know that the quality of pre- and post-natal care a person receives when a child is born has a direct impact on how soon they’re able to return to work (if they choose to). If we want our children to grow up healthy enough to become functioning, contributing members of society, then the quality of care they receive from birth throughout childhood can’t be underestimated.
“We do not know where and when the next global pandemic will occur,” Tedros admitted, “but we know it will take a terrible toll both on human life and on the economy.”
While Tedros acknowledged there’s no guarantee we’ll one day create a completely pandemic-free world, what is within our reach — if we have the investment and support — is a world where humans, not pathogens, remain in control. We can do better. And if most of us are to survive in the long term, we must.
In 1918, the United States fought two wars. One it lost, and one it won.
You may have learned about World War I in history class, or even from your relatives. As a member of the Allied Forces, the United States defeated the Central Powers — a victory touted by history books, movies, and novels.
The second war, however, had a more elusive opponent. It descended perniciously, quietly claiming lives while armies concerned themselves with foxholes and mustard gas. In the first six months, this enemy killed 25 million people worldwide.
Ultimately, between 50 and 100 million lives — five percent of the world’s population at the time — would be lost as a result of the conflict.
This second enemy was, of course, the flu virus. By the time Americans realized that the country was under siege, it was too late to stop it. The flu made its way through the U.S., Europe, and Asia with terrifying speed; people who had been well in the morning dropped dead in the street by dinner time. Families that had already lost sons, fathers, and brothers to the war abroad dwindled as the virus attacked them, affecting the remaining young and healthy. In just one year, the average life expectancy for an American dropped by 12 years.
Over the century that followed, Americans would face three more pandemic flus, but none of them like the one in 1918. The 1957 pandemic flu killed roughly 1.1 million people worldwide; another in 1968 wiped out about another million globally. Most recently, the 2009 H1N1 pandemic flu killed between 151,700 and 575,400 people worldwide, according to estimates from the Centers for Disease Control and Prevention (CDC).
Today, a century after the 1918 pandemic, we know much more about the virus — how it spreads, how it kills. We now have influenza vaccines — unheard of in 1918 — that provide us with (albeit limited) protection. And sophisticated tracking mechanisms help us predict which flu viruses we might encounter in a given year.
We have not, however, completely vanquished the flu. In this particularly bad flu season in the U.S., we need little reminder that the virus is hardy and evolves rapidly. The flu that ravaged humanity in 1918 is not the same strain making headlines in 2018. Likewise, if another global pandemic flu is inevitable, we can’t assume the virus will be one we’ve seen before.
Today, our relationship with the flu has shifted from an adversarial, bellicose one, to one of competition; we are running a race, no longer fighting a war. To survive another century, or another season, public health experts will need stay one step ahead, armed with an artillery provided by science and a war plan drafted from the history of the battle we lost.
Why (and How) the Flu Still Kills
A high fever, fluid in the lungs, crushing fatigue, and body aches — if you’ve ever come down with influenza, it likely needs no introduction. It’s often easy to distinguish the full-blown flu from the common cold because the flu’s symptoms tend to come on suddenly and with an intensity that makes it hard to deny.
When a person is infected by any pathogen — a virus or bacteria — they usually won’t know it until that pathogen has started damaging cells. That kicks the immune system into gear, making you start to feel sick. The fever, aches, and mucus all too familiar to flu-sufferers aren’t from the virus itself, but rather are the side effects of the body’s attempt to vanquish it.
Even though our immune systems respond rapidly and with such force, they aren’t always successful in stopping the microbes wreaking havoc on the body’s cells. While most of us who get the flu just stay home and rest, the flu makes some people seriously ill — they have to be hospitalized. Some even die as a result of complications from the flu.
(The flu doesn’t directly cause death. Instead, the virus can induce an infection like pneumonia, or exacerbate an underlying condition. But oddly enough, it’s usually the body’s too-aggressive immune response to the flu that ultimately kills people).
Those caveats make the data on this year’s flu season more striking: as of the first week of February, the number of flu cases in the United States was the highest since the 2009 pandemic. The most people have been hospitalized at this stage in the flu season since the CDC started tracking, in 2005. Both numbers are still climbing.
When we talk about the flu, we aren’t talking about a single virus. There are four types of influenza viruses — but only two of them cause serious illness in humans, Catherine Beauchemin, an associate professor of virophysics at Ryerson University in Toronto, explained to Futurism. You might remember hearing about H1N1 (the flu type that hit us in 2009) and H3N2 (the type of flu causing problems this year) — those Hs and Ns stand for hemagglutinin and neuraminidase, proteins found on virus’ surfaces that help either enter cells (H) or separate from cells to go infect another cell (N). The numbers identify groups of strains with similar Hs and Ns.
The flu mutates remarkably quickly, changing dramatically to dodge our antibodies in the span of a flu season or two. That means it can infect people who previously contracted it.
That’s why we get flu shots every year. Even though researchers have a sophisticated global tracking system to anticipate which strain might affect a region in a given year, there’s still a surprising amount of guesswork involved.
Flu seasons typically occur during the colder months, when people are more likely to congregate indoors. Because the flu season is opposite in Australia, the CDC’s Epidemiology and Prevention Branch in the Influenza Division can track that country’s flu season about six months before flu season arrives in North America. As travelers move the virus from Australia to Europe, Asia, and the U.S., public health experts can anticipate which strain will likely be the one to make people sick in the northern hemisphere that year.
For a virus that evolves so quickly, that lead time can also be problematic. “There have been instances where the viruses have changed between when the recommendations have been made and when the vaccine has been administered, leading to suboptimal performance.” Webby added. For example, the latest data on this year’s flu vaccine shows it’s around 17 percent effective, though that may change before the flu season ends.
This year’s flu virus, H3N2, isn’t like other strains that have circulated in recent years. It binds to cells differently, and seems to be mutating more rapidly, making it difficult to study and create a vaccine against. The strain also doesn’t grow well in eggs, where bacteria are most commonly grown before being put into vaccines.
“We don’t have a flu vaccine problem so much as we have an H3N2 vaccine problem,” Ed Belongia, a vaccine researcher and director of the Center for Clinical Epidemiology and Population Health at Wisconsin’s Marshfield Clinic, recently told STAT News.
Although we can identify and classify them, track them, and create vaccines to defend against them, the viruses continue to evade us, evolving faster than we can keep up — sickening or killing people in the process.
Fighting the Flu of the Future
In 1918, many of the treatments we have today for secondary infections like pneumonia or strep throat either didn’t exist or were not yet widely available. That partially explains why the epidemic killed so many.
In 1918, many people felt that the flu descended upon their community out of nowhere. Today, we can at the very least see the flu coming so our doctors and emergency rooms can be prepared — even if we don’t have weapons powerful enough to completely stop it yet.
One elegant solution is to gather data from smart devices sick people usually use to track the spread of the flu. Smart thermometer company Kinsa does just that. Over the past six years, the device’s 1 million users gather real-time data to track infectious disease with the help of “smart thermometers” and a smartphone app. Though it may seem counter-intuitive that a relatively small number of users could track how many people have the flu and where, the flu-tracking data over the past two years has lined up with CDC data — and the app is gathering it much more quickly than public health agencies are able. Nationally, the number of people with the flu is 39 percent higher than it was at this time last year, according to Kinsa’s most recent report.
Some are thinking bigger than treating or tracking the flu. The holy grail for flu treatment would be a vaccine that doesn’t change from year to year depending on the annual strain. If everyone could just get the vaccine once to protect us from all strains of flu for our entire lives, hundreds of thousands of lives could be saved every year.
A team of researchers out of UCLA is genetically-engineering flu viruses that could become candidates for a universal vaccine. The researchers engineered flu cells to stimulate a bigger, more targeted immune response than the real-life strains. So far, the team has only developed the potential vaccine in the lab; the researchers hope to test two strains in animal models before moving into human trials.
Pharma company BiondVax Pharmaceuticals recently completed Phase 3 clinical trials for its universal vaccine candidate, which incorporates synthetic compounds. It has already received a patent in India. This type of vaccine targets specific areas on the surface of a flu virus that determine the phase and severity of the immune response. Being able to “ramp up” or “tamp down” different aspects of that process in animal models has convinced researchers that the vaccine could be useful in preventing other infectious disease beyond the flu, such as HIV and malaria.
FluGen, a startup out of the University of Wisconsin-Madison, is also working with a genetically-mutated form of the virus to make a universal vaccine. According to FluGen’s website, the company’s genetically-altered viruses have had a gene deleted so that they “can infect cells, express the entire spectrum of influenza RNA and proteins, yet cannot produce any infectious virus particles.”
But to get there, the researchers encountered substantial controversy. You have to break a few eggs to make an omelet; to create a vaccine against mutating flu viruses, you’ll have to mutate a few flu viruses. Researchers worked to avoid creating some kind of super-virus. When the researchers mutated the H1N1 virus from the 2009 pandemic, and when they recreated the 1918 pandemic flu, the global scientific community called their methods and safety into question.
Other researchers, like those on a team at Georgia State University, are harnessing nanoparticles to facilitate a universal vaccine. Most vaccines target the outside surface of a virus’s protein, which varies across different viruses. But if nanoparticles could target further down, on a part of the protein called the stalk, a vaccine could have broader efficacy. In experiments detailed in a study published in Nature Communications in January 2018, mice inoculated with nanoparticles containing the protein to elicit an immune system response were completely immune to four different strains of the flu, including this year’s H3N2. They will need to conduct more animal studies — first in ferrets, as their respiratory systems are quite similar to those of humans — before testing the vaccine on humans.
But these challenges are not insurmountable. A universal vaccine could be possible within a generation. How well it works, well, that’s another question.
As 1918 came to a close, the editors of the Journal of the American Medical Association published its final edition for the year. The editors reflected on what could be learned from the two wars humanity fought that year, then turned their attention to the future.
“Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there,” they wrote. “Now, it must turn with its whole might to combating the greatest enemy of all — infectious disease.” In another century, perhaps the flu of today — the damage it causes, the lives lost to it — will seem equally distant, perhaps even innocuous.
The National Institutes of Health (NIH) has lifted a three-year freeze in federal funding for research projects pertaining to germs that can cause pandemics. The Department of Health and Human Services (HHS) released a new framework dictating how research that could create newer and deadlier germs with pandemic potential is funded.
“We have a responsibility to ensure that research with infectious agents is conducted responsibly, and that we consider the potential biosafety and biosecurity risks associated with such research,” wrote NIH director Francis S. Collins in a statement published on the organization’s website. “I am confident that the thoughtful review process laid out by the HHS P3CO Framework will help to facilitate the safe, secure, and responsible conduct of this type of research in a manner that maximizes the benefits to public health.
Pandemics are disease epidemics that occur worldwide and affect a large number of people, like the Spanish Flu in 1918 that killed nearly 50 million people. Typically, scientists manipulate existing pathogens – making them deadlier or easier to pass on – to better understand them and develop countermeasures against those that may threaten public health.
But the funding ban was put in place after a string of incidents involving avian flu and anthrax that raised concerns about the consequences of an accident occurring in a lab. Any research involving influenza, severe acute respiratory syndrome (SARS), or Middle East Respiratory Syndrome (MERS) viruses was blocked.
The issue has become a point of contention among members of the scientific community. While some argue that this work is an essential component of preparing for future pandemics, others maintain that the risks are too great.
“The public and regulators are looking for science-based advice, but, in this case, there is still considerable disagreement within the scientific community,” explained Daniel Rozell, a research assistant professor in the department of technology and society at Stony Brook University, in an email correspondence with Futurism.
“Furthermore, there is some unavoidable bias in the advice. Some of the virologists most acquainted with the specifics of the research have careers that depend on its continuance,” he said. “While they may have the best of intentions, there is still a tendency to underestimate familiar risks and to be partial towards one’s own efforts.”
Risk and Reward
When funding was paused in 2014, the NIH Office of Science Policy was tasked with carrying out a “comprehensive, sound, and credible” risk-benefit analysis to inform how the situation should be handled. Even this analysis proved contentious. However, risk assessments don’t just serve to determine whether or not the research can be carried out safely – they can establish best practices for doing so.
“A risk-benefit assessment is still a useful exercise because it can be used for risk exploration,” said Rozell. “When researchers are cognizant of the most likely hazards arising from a line of research, they can take steps to redesign the research to achieve the same outcome without the potential for unintended consequences.”
Research into pandemic pathogens could play a vital role in ensuring that we can respond appropriately to an outbreak – but it’s crucial that such research is carried out in such a way that it doesn’t end up causing the very situation it’s meant to address.
The general public is intimately familiar with being sick. They know how diseases and viruses can harm the body and cause a variety of symptoms — exhaustion, headaches, joint pain, etc. But despite this public knowledge, one aspect that is often misunderstood or ignored is how diseases spread, and how quickly they can pass from person to person. Sure, an epidemic or a global pandemic may sound bad, but surely we’re advanced enough as a civilization that we no longer has to worry about such things, right?
At the time, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, explained that without new drugs, common disease have the potential to become a serious threat to society.
“There is an urgent need for more investment in research and development for antibiotic-resistant infections including [tuberculosis], otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery,” Dr. Tedros Adhanom Ghebreyesus said.
According to Business Insider, former director of the Centers for Disease Control and Prevention (CDC), Tom Frieden, believes that the world would greatly benefit from looking to past, citing the Ebola outbreak as a situation that could help us to prepare for future epidemics.
“If we don’t take action very quickly to close the gaps that are being identified, we will lose that opportunity,” he said.
Speaking to Futurism over email, Dr. Gerald A. Evans, a Professor of Medicine, Biomedical & Molecular Sciences and Pathology & Molecular Medicine at Queen’s University, had a more specific preventive measure he thinks should be developed: surveillance.
“Without question surveillance and cooperation between surveillance networks to locate & define emerging pathogens,” explained Evans. Currently, surveillance operations are in need of improvements to keep up with the modern world. But those changes require serious financial support. There also need to be healthier relationships between countries and their respective governments and organizations.
“With our current global political culture showing inward looking concerns, this seems unlikely to happen soon,” Evans added.
Evan’s thoughts on what needs to be updated and further developed don’t end at just surveillance. In the future, he would also like to see more research done into novel vaccine & drug development, particularly research that will accelerate the rate at which vaccines and treatments are produced. Beyond that, Evans sees that the world is in need of a more robust global infrastructure. Such a thing will be necessary if we want to “care efficiently [for] affected persons in resource-poor settings, not just the developed world.”
We’re Due for an Epidemic
But how close are we to experiencing a global pandemic? Which disease will be the culprit? When we posed this question to Dr. Evans, he said that we’re definitely due for one within the next several decades. By 2070, our next big viral outbreak may have already happened.
“Without question and almost a certainty within the next 50 years,” said Evans. “The only unknowns are: When? And from which pathogen?”
Evans continued, comparing the likeliness of a pandemic to an asteroid impact, saying, “The most likely pathogen to cause a pandemic would be a respiratory zoonotic (meaning animal derived) virus. This is similar to the questions about will Earth be struck by a large asteroid, the only thing is that pandemics are far more frequent than asteroid encounters.” Asteroids are also unlikely to wipe out humanity.
Some predict that the world will be rocked by a pathogen much sooner. At the 53rd Munich Security Conference in February, Microsoft founder and philanthropist Bill Gates said that nearly 30 million people could be killed by an airborne pathogen within the next 15 years. Compared to Evans’ prediction, Gates’ is much more dire and immediate.
Gates stated that “Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year. And they say there is a reasonable probability the world will experience such an outbreak in the next 10-15 years.”
Caring for Ourselves
Despite our level of pandemic preparedness being lower than some advise, our problems may start even before any hypothetical pathogen arrives. As stated previously, the general public can comprehend the idea of bacteria spreading, but people are less likely to understand — or care — about how quickly bacteria can do so. As long as that key piece is ignored, we may never be capable of putting up a real fight against pandemics and outbreaks.
“Absolutely, the lay public underestimates the likelihood and rapidity that this could happen; just look at the 2009 H1N1 influenza pandemic,” responded Evans when asked about people failing to properly respond to the spread of viruses. “[H1N1] spread out of US & Mexico within weeks and was documented worldwide within a month of it being first documented in California. And it was not that ‘contagious’ a virus.”
We haven’t lost the fight against pandemics yet, though it’s also too early to say if we’re capable of winning without major losses. A significant amount of work still needs to be done before the next global outbreak hits, but it’s not impossible to accomplish this. In the end, it all comes down to knowledge — how much humanity understands about diseases and viruses. If we can implement the changes and improvements suggested by Dr. Evans and accelerate research into cures and treatments, the next global pandemic will become history soon after it begins.
In a race to prevent future deadly pandemics, scientists are trying to pinpoint the animals and regions where the next Ebola or Zika might arise — before the viruses start harming people. But some experts argue that it makes more sense to look for new viruses in humans, not other animals. In fact, the next emerging infectious disease is probably already out there, making people sick.
Animals host a massive number of viruses, and sometimes these viruses make the jump to humans. (These viruses are called zoonoses.) This happens pretty rarely, but when it does, it can wreak havoc: most pandemics in recent memory like HIV, pandemic influenza, and Zika were caused by viruses that started out in animals….